Shining the Spotlight on Bruce Willis and Aphasia

The Hollywood spotlight that has shown on Bruce Willis for almost 40 years, from the TV show Moonlighting in the late ’80s to the movie franchise Die Hard and beyond, is now shining on aphasia, a common disorder in adults over 60 that affects speech and language, and is usually caused by some sort of brain injury, such as a stroke or a brain tumor. As you have most likely heard, the legendary actor is stepping away from his career because he is suffering from aphasia.

Willis, 67, reportedly began experiencing symptoms five years ago. One of the first reported instances came from the set of the film Glass in 2017, during which two production sources said the actor appeared “slightly off,” struggling to handle lines and performances on set. Since then, his condition has persisted.

Aphasia Ranges Greatly in Severity

A lesser-known individual, retired pastor Glenn Teal, underwent surgery earlier this year after he experienced a brain bleed in December. Following the surgery, he wasn’t able to tell time and could hardly read.

Teal was later diagnosed with Broca’s aphasia, or mild expressive aphasia. With this particular type of aphasia, people can understand what others are saying but they are unable to present thoughts or speak clearly themselves. It is difficult to get the words out, and those with the condition tend to omit words when they are speaking. Since Teal’s form of aphasia is mild, he has since been doing outpatient therapy twice a week. He also practices at home by reading Dr. Seuss books, going over vocabulary, and reading his Bible. Teal should make a full recovery from his aphasia.

On the other end of the spectrum is primary progressive aphasia, which is a type of frontotemporal dementia, a progressive and degenerative disease that includes a group of related disorders resulting from the degeneration of the frontal or temporal lobes of the brain, which are the parts of the brain involved in speech and language processing. Aphasia can also be an early symptom of various types of dementia. The media does not specify which type Bruce Willis has, or if it is even known at this point.

What Causes Aphasia?

According to the Cleveland Clinic, aphasia is a disorder that results from damage to areas of the brain that produce and process language, which often happens if someone has a stroke or brain injury. A person with aphasia can have trouble speaking, reading, writing, and understanding language. Impairment in these abilities can range from mild to very severe (nearly impossible to communicate in any form). Nearly all patients with aphasia have word-finding difficulties, including coming up with the correct name of persons, places, things, or events.

Aphasia can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage, such as dementia. Some patients have even been diagnosed with aphasia after experiencing COVID-19, though it affects each individual differently. Aphasia is life altering for the people who have it and also for families and loved ones.

The Main Manifestations of Aphasia

People with aphasia generally have one of three different manifestations of the disorder.

• Expressive aphasia. Also called Broca’s aphasia, expressive aphasia is characterized by someone understanding what other people are saying better than they can speak. People with this type of aphasia typically struggle to find the correct words, speak in short sentences, and often leave out words, but a listener can usually still understand what the person with expressive aphasia is trying to say. Individuals with expressive aphasia are usually aware of their difficulty communicating and often get frustrated with themselves. Expressive aphasia is most often caused by a stroke and is quite often accompanied by right-sided paralysis or weakness.
• Comprehensive aphasia. Also called Wernicke’s aphasia, individuals suffering from comprehensive aphasia may speak easily in long, complex “sentences,” but these “sentences” often come out as gibberish — jumbled words incomprehensible to the listener. Sadly, individuals suffering from comprehensive aphasia usually don’t realize that others can’t understand them. Comprehensive aphasia, similar to expressive aphasia, also typically results from a stroke or other brain injury.
• Global aphasia. Individuals with global aphasia may only be able to produce and understand a handful of words, and they frequently can’t read or write. Global aphasia is caused by damage (again, typically from a stroke) to significant parts of the brain that control both speech and language comprehension.

How Common Is Aphasia?

Aphasia affects nearly two million people in the United States — it’s more common than Parkinson’s disease, cerebral palsy, or muscular dystrophy. Most people had not heard of aphasia prior to the Bruce Willis announcement because aphasia is typically not a disease in itself but rather a symptom of a brain injury such as a stroke or a brain tumor, except for primary progressive aphasia, discussed below. Most people living with aphasia are middle-aged or older, as the average age of those living with the condition is 70. But anyone, including young children, can acquire it.

Primary Progressive Aphasia

Primary progressive aphasia, a type of frontotemporal dementia, is a condition that slowly damages the parts of the brain that control speech and language. People with primary progressive aphasia usually have difficulty speaking, naming objects, or understanding conversations.

What Causes Primary Progressive Aphasia?

The symptoms of primary progressive aphasia are caused by degeneration in the parts of the brain that control speech and language. This type of aphasia begins gradually, with speech or language symptoms that vary depending on the brain areas affected by the disease. For example, in one type of primary progressive aphasia, people may initially have trouble producing speech, whereas in another variant, word-finding and comprehension problems are more pronounced. Individuals suffering from Primary Progressive Aphasia may manifest symptoms in three different generalized types, similar to the three types of manifestations discussed above.

Is Primary Progressive Aphasia Treatable?

The majority of people with primary progressive aphasia have trouble expressing themselves with language, while their memory stays mostly intact, especially during the first two years of decline. Difficulties reading and writing may develop as the disease progresses.

To treat primary progressive aphasia, maintaining adequate communication and social connections are critical. There is no cure for dementia, including primary progressive aphasia. So, unlike many people who develop aphasia from head injury or stroke, people with primary progressive aphasia do not typically improve with time, but a therapist may be helpful in maximizing abilities and exploring other ways to communicate. Nonverbal techniques for communicating, such as gesturing or pointing to pictures, may help these people to express themselves.

Planning in Advance

Do you have a loved one who is suffering with aphasia? Please know that you can call us at one of the numbers below to make an appointment for an initial consultation:

Elder Law Fairfax: 703-691-1888
Elder Law Fredericksburg: 540-479-143
Elder Law Rockville: 301-519-8041
Elder Law DC: 202-587-2797